Jaundiced, When Baby’s Eyes Are Yellow

While working at one of the inner city hospitals in New York City, I had the burden of telling a mother that her new born will not go home as planned because baby’s skin is too yellow—jaundiced and that the baby needed to be treated with light {phototherapy}.

 

After hearing my assessment, the mother broke down and began crying. ‘This is not a cause to cry for’, I said, ‘your baby will be okay’. I went on to tell her about the baby’s condition and what I intended to do about it.

 

There is a long list of what can cause jaundice in the newborn. This article addresses only the commonest kind of jaundice occurring in the newly born baby.

 

Bilirubin and jaundice

Bilirubin is name of the pigment that stains the body; skin, eyes and other tissues yellow. It comes from broken down, or hemolyzed red blood cells. The form of bilirubin responsible for most of the jaundice seen in the newborn is known as the unconjugated bilirubin. When their levels are high, they stain the body. When their level is dangerously high, they can injure the developing brain.

 

What is jaundice?

Jaundice is a term used to describe yellowness of the skin, eyes or other parts of the body. It can occur in both young and old. For the purpose of this article, yellowness of the skin and jaundice has the same meaning and are used interchangeably.

 

How do I know when my baby has jaundice?

 Yellowness of the skin can easily be seen by experienced parents—–who had babies with jaundice. Moreover newborn babies are looked over and examined multiple times a day by doctors and health care providers for jaundice. Eye examination is highly subjective. Two experienced health care providers may differ on whether a baby is jaundiced or not based solely on eye observation. Laboratory Confirmation is frequently needed.One of the ways is to collect blood from the baby’s heel. The blood is then taken to the laboratory for analysis of the degree of jaundice.

 

 Where does the yellowness come from?

The yellowness or jaundice comes from a pigment called bilirubin. Bilirubin comes from broken down red blood cells. The baby’s liver is supposed to get rid of bilirubin. Two general reasons may account for babies jaundice:

• There are more than expected red blood cells death, breakdown
• The baby’s liver enzymes responsible for facilitating the excretion of bilirubin are not fully functional or activated.

 

The yellowness or jaundice comes from a pigment called bilirubin. Bilirubin comes from broken down red blood cells. The baby’s liver is supposed to get rid of bilirubin.

 

Two general reasons may account for babies jaundice:

• There are more than expected red blood cells destruction, breakdown
• The baby’s liver enzymes responsible for facilitating the excretion of bilirubin in the stool and in the urine are not fully functional or activated.

 

Physiological jaundice

A gentle rise of bilirubin during the first three days of life, followed by a gradual fall within five days of life is expected in many newborns. This normal trend of rise and fall in bilirubin level is called physiological jaundice. Bilirubin levels in physiological jaundice can go from 2 mg/dl to about 12 mg/dl. And by the time the baby is 5-7 days old, the level falls back to around 2mg/dl or below. No treatment is needed for most physiological jaundice.

 

Is it my fault that my baby is jaundiced?

Health practitioners frequently mention incompatibility [rhesus antigen type, or the ABO blood group type] between the baby’s blood and the mother’s blood as one of the many causes of jaundice in the newborn. Mothers with such ‘set-up’ may express some guilt. No such guilt is warranted.

 

Ordinarily babies and mothers blood do not mix during pregnancy. However in some special circumstances, small quantity of babies blood crosses through the placenta to the mothers blood. And if these baby’s cross over cells are incompatible with mothers surveillance system, the mother’s system will mount a defense [produce Immunoglobulin G, IGG] against them. Unfortunately these IGG will carry the fight over to the baby’s side, and indiscriminately destroy babies red blood cells. A baby still in the womb can be very sick or even die if this happens, because lots their red blood cells have been destroyed in the process. In the rhesus antigen type, this leads to severe anemia and a condition called hydrops fetalis. The ABO blood group incompatibility type is not as severe as the rhesus type; however babies can be very jaundiced.

 

Why is high bilirubin dangerous in babies?

High level of bilirubin in the body causes injury and damage many organs of the body. Parts of the body mostly affected include the cells of the brain, especially areas of the brain responsible for movement [cerebellum and the basal ganglia], areas responsible for memory [the hippocampus]. Bilirubin is also deposited in tissues of the kidney, intestine and pancreas.

 

Treatment

 If health practitioners noted that that a newborn is jaundice, they would determine whether to treat or whether to let the body resolve the condition. In cases of physiological jaundice where the bilirubin is below 12 mg/dl or so and the newborn is healthy, watchful observation and continuing monitoring of the level is all that may be necessary. In cases where the level of bilirubin is above 12 mg/dl and or rising, treatment intervention may be started.

Phototherapy is a very popular treatment used to bring down bilirubin level

• Irrespective of the causes of the jaundice, the urgent consensus is in trying to stop the bilirubin from further rise and to bring its level down.

 

• It is only used to bring down the unconjugated form of bilirubin

 

Phototherapy is a popular method of achieving the above result. In phototherapy treatment, a set of standardized light is directed over babies for hours at a time. Babies can be taken out for feeds and returns for light treatment. Baby’s eyes are protected from the phototherapy light. Phototherapy works by configuring unconjugated bilirubin to a more soluble structural form, isomerization. A more soluble which can then be easily excreted by the liver

 

A test of Rh status is part of routine prenatal test in women. Those women who are Rh negative are at risk———- [especially if the unborn baby carries Rh positive antigen, gotten from father] of developing antibodies against their baby’s red blood cells. As a preventative measure, women who are Rh negative are treated with a shot of 300ug of 1 ml RhoGam [Anti-D globulin]. This medicine disables those baby’s Rh positive red blood cells that have crossed to mother’s blood, hopefully before they can elicit an immune response. Mothers can receive RhoGam to protect their current pregnancy or subsequent pregnancies. In an already sensitized mother, RhoGam is more protective during second and subsequent pregnancies.